Treating GERD Without Medications or Major Surgery


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By Monica Saumoy, MD

Gastroesophageal reflux disease (GERD) is a common and uncomfortable condition affecting millions of people across the United States.

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Characterized by the frequent and chronic backflow of stomach acid into the esophagus, GERD can lead to a range of symptoms and complications if left untreated.

In fact, in severe cases, GERD can cause a condition called Barrett’s esophagus, which can lead to esophageal cancer.

The Esophageal Program at the Center for Digestive Health at Penn Medicine Princeton Medical Center offers specialized care for diseases of the esophagus, using advanced diagnostic and treatment techniques, including noninvasive surgery that provides long-term relief from GERD.

Common GI (Gastrointestinal) Disease

When you swallow, the valve at the bottom of your esophagus relaxes so food and liquid can flow into your stomach.

When that valve is weak or does not function properly for one reason or another, acid and
gastric juices can flow back up into the esophagus, often causing what is commonly referred to as heartburn.

And while almost everyone will experience heartburn every now and then, especially after a big meal, if it occurs frequently — two or more times a week — it is likely a sign of GERD.

GERD is one of the most common GI diseases in the U.S., according to the American College of Gastroenterology, affecting approximately 20% of people nationwide.

Symptoms May Vary

Symptoms of GERD vary from person to person, and though frequent heartburn is a common sign of GERD, some people with GERD may not experience heartburn at all.

In addition to heartburn, other common symptoms of GERD include:

  • Regurgitation or the feeling of stomach contents rising into the throat or mouth.
  • Difficulty swallowing.
  • Chronic cough, especially at night.
  • Hoarseness or changes in voice.
  • Sore or irritated throat.
  • Laryngitis.

Left untreated, GERD can lead to a number of complications, such as:

  • Inflammation and damage to the esophagus lining.
  • Narrowing of the esophagus, making swallowing difficult.
  • Respiratory issues, including the worsening of asthma and aspiration pneumonia.
  • Dental problems, erosion of tooth enamel.
  • Barrett’s esophagus, a condition that increases the risk of esophageal cancer.

If you suspect you have GERD, consult your physician for a proper diagnosis and treatment plan.

A Range of Options

A range of options are available for the treatment of GERD depending on its severity. In some instances, lifestyle changes such as maintaining a healthy weight, not overeating, and avoiding caffeine, alcohol, chocolate and spicy foods can help reduce the symptoms of GERD.

If those changes are not enough, medication is usually the next step in treatment. Over the counter antacids can often provide temporary relief, while certain prescription medications can work to reduce acid production.

A Noninvasive Surgical Approach

When lifestyle changes and medication fail to resolve GERD, a procedure called transoral incisionless fundoplication (TIF) may be recommended.

The noninvasive procedure is performed through the mouth with an endoscope, which enables the gastroenterologist to see inside the esophagus and stomach.

During the procedure, the gastroenterologist uses other specialized tools to wrap the top part of the stomach around the bottom part of the esophagus, helping to lengthen and strengthen the esophageal valve.

As a result, the valve works better to keep acid and stomach contents from coming back up into the esophagus.

The TIF procedure is a safe and effective alternative to other more complex surgeries for GERD. Patients often have an easier recovery and are typically able to return to a normal diet after six weeks. Moreover, the procedure does not preclude additional interventions if they are needed to treat the condition in the future.

Most people suffering from GERD that is not able to be controlled through lifestyle changes or medication are candidates for TIF, unless they have a large hiatal hernia. In those cases, traditional open or laparoscopic surgery can be performed.

At the Center for Digestive Health at Penn Medicine Princeton Medical Center, the TIF procedure is performed by clinicians with expertise in the management of GERD.

Tips for Prevention

Preventing GERD may not always be possible without treatment, but the American College of Gastroenterology offers these tips to decrease the amount of acid that reaches the esophagus:

  • Raise the head of your bed. Use an under-mattress foam wedge to elevate your head six to 10 inches.
  • Change eating and sleeping habits. Avoid laying down for two hours after eating. Do not eat for at least two hours before bedtime.
  • Avoid tight clothing.
  • Maintain a healthy weight. People who are overweight are significantly more likely to have GERD compared to those with ideal body weight.
  • Change your diet. Avoid foods and medications that trigger GERD (fats, chocolate caffeinated drinks, alcohol) and those that may irritate the esophagus (citrus fruits tomatoes).
  • Do not smoke. Smoking relaxes the esophageal valve and stimulates acid production.

Most importantly, don’t ignore recurring heartburn or other symptoms of GERD. See your doctor, who may refer you to a gastroenterologist for care. With the right treatment, you can reduce your symptoms and avoid complications down the line.

To find a gastroenterologist with Penn Medicine Princeton Health or for more information, call 1 (888) 742-7496 or visit

Monica Saumoy, MD, is board certified in gastroenterology, obesity medicine, and internal medicine. She is a member of the medical staff at Penn Medicine Princeton Health.

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